PREFACE WHY THE INTEREST IN NECK AND BACK PAIN?
It seems that everyone has suffered neck or back pain at some stage. Neck or back pain affects between 60% and 85% of people. Probably you are one of these people. In one study, researchers reported that 21% of patients experienced back pain in the 14 days preceding the study. Another study reported that at least 5% of all patient visits to the doctor are due to back pain.
Tremendous costs are involved. Neck and back pain account for half the worker's compensation payments in the United States and Australia, they are the single greatest cause of lost work time in both countries, and low back pain alone costs over $85 billion annually in the United States, about one-third of this amount being the direct costs of medical care. The 10% or so of patients who suffer chronic back pain account for 75% of Australia's rehabilitation and compensation payments. The social cost cannot be calculated -- back pain is the most frequent cause of inactivity among people under 45 years of age. In the U.S., Great Britain and Australia, the number of people disabled by these problems has increased exponentially since the 1970s, during a period of only modest population increase (Schwarzer, 1996; Rainville et al., 1996).
However, patients are not the only ones to suffer. Back pain has been described as "a wilderness across whose inhospitable terrain orthopedic surgeons, neurosurgeons, physiotherapists and, above all, general practitioners are doomed to travel" (Littler, 1983). Most doctors believe "there is little doubt that most cases are due to derangement of the intervertebral joint in association with 'degeneration' of the disc and arthrosis of the facet joints" (Ganora, 1984), or, as it was put more simply, "more than 95% of patients with low back pain suffer from mechanical back pain" (Schwarzer, 1996, p. 108). And yet an article in the New York Times about a study published in the New England Journal of Medicine raises serious doubts about these claims: nearly two-thirds of a group studied had "spinal abnormalities, including bulging or protruding discs, herniated discs, and degenerated discs" -- but none of the subjects in the study had back pain, or ever had suffered from this problem (Kolata, 1994).
What is this book about?
I have found that most neck and back pain is experienced in the muscles associated with the spine. The pain is caused by excessive tension held in these muscles and is the result of a variety of causes, from structural imbalances to various aspects of lifestyle. These causes can be treated. Except for a very small percentage of neck and back pain which can be dealt with successfully by surgery or drug therapy, I advocate a conservative, exercise-based approach, the subject of this book.
What can I do?
My approach to overcoming neck and back pain has two parts. The first step is to help you identify which muscles are involved in your particular problem and to teach you the most efficient ways to relieve this excess tension, using extremely efficient stretching exercises, initially to be done only twice per week. This phase of treatment the rehabilitation phase) is enhanced by teaching you how to use directed relaxation to assist the body to sleep and to enhance its healing tendencies.
The second step (the prevention phase) conditions all of the relevant parts of the body by using more advanced stretching exercises and later, by adding specific strengthening exercises, to provide a measure of protection for the future. In these two chapters, I shall present an approach to neck and back pain that is effective in practical terms and a later chapter considers the problem in theoretical terms, and will help you to make sense of the conflicting research on the problem.
Who should use this book?
This book is written for anyone who suffers recurring neck or back pain, or who wishes to avoid these problems. Recovery isn't quick or simple, but there aren't many other options either. Unless your back or neck problem is of the kind that can be treated effectively by surgery or drug therapy (probably less than 10% of the cases presented to general practitioners), you may have found that the range of options seems limited to avoidance of the activity thought to be the cause or treatment of the symptoms. If treatment is successful, your back will be returned to normal; that is, to its "preinjury" level of function -- consequently, there is no guarantee that the problem will not return. My aim is to present a unified and comprehensive self-help approach. For those fortunate enough not to have such problems, the approach will increase the suppleness and strength of your neck and back to reduce the likelihood of injury to these areas.
How this book is set out
The introduction sounds a more personal note than following chapters. It begins with a brief history of events which led me to my current approach, including a rather lengthy stay in Japan where I studied Shiatsu and a number of traditional exercise systems. I consider the various exercise systems from which I derived my own, the courses called Posture & Flexibility, and Strength & Flexibility, currently taught at the Australian National University. My clinic in Canberra (the Shoshin Center) is mentioned, and I present some relevant neck and back pain case studies. The first three chapters include the self-diagnosis method, and the stretching and strengthening exercises -- these are the nuts and bolts of my approach.
Chapter one takes you through the self-diagnosis step-by-step. There is a flow-chart of the diagnosis method at the end of the chapter, and a page to photocopy. On this you fill out the results of the leg length tests and the functional flexibility tests. Fill it in as you go through the chapter. There is also an illustration of where pain may be experienced in the neck and back, and exercises likely to be useful are listed alongside.
Chapter two contains the basic pain-relieving and rehabilitation exercises; the first section describes exercises for the back, and the second describes exercises for the neck. These are the most important exercises in the book, and for most people are the only ones they need to do on a regular basis.
Chapter three details the preventive stretching exercises. These are designed to improve and balance your existing flexibility, and allow you to focus more closely on your problem areas with stronger techniques. The second part of chapter three outlines my approach to strengthening exercise, and details a set of graded strength exercises, from a minimal set suitable for doing at home through to more elaborate exercises for which some equipment is needed.
However, do not go straight to the exercises without reading the cautions section below. Inappropriate exercise may worsen your condition, and the nature of the problem is the best guide to selecting the exercises which are right for you.
You will get more out of the exercises if you have a reasonable working knowledge of the anatomy of the areas of interest. For this reason, useful functional anatomical information will be found together with the exercises. Organizing the book this way means that you do not need to go backwards and forwards between the exercises and the anatomical details upon which the exercises so crucially depend. As mentioned, much experience has shown that the actual locus of neck or back pain tends to be the muscles associated with the spine. As each muscle has a clearly definable function, this knowledge will help you locate the particular group concerned, and guide you to the best exercise. The book has been bound so it can be left open on the floor beside you, to enable you to check your form as you practice, and the practical sections include Notes (presented in a larger typeface than the text) that contain the most important details about how to do each exercise. These are arranged alongside the photographs for easy reference.
Chapter four discusses the various causes of neck and back pain, from a number of medical perspectives beginning with that of western medicine. One of the reasons for so doing is that western medicine has the most detailed understanding of anatomy, and this knowledge is fundamental to my approach. Another reason is that we are familiar with the western medical perspective -- it is the medicine of our culture. This chapter includes a brief consideration of chiropractic and osteopathy because neck and back pain is the main concern of these practitioners. Oriental medicine and some of the bodywork schools are also considered. Acute and chronic pain are treated separately, and mention is made of additional contributing factors. The chapter sounds a note on the limitations of the very idea of cause with respect to common illnesses, and offers a rationale for my functional approach. The experiences of the workshops we have been running for individuals and practitioners are presented, and consideration is given to choice of beds and pillows.
Chapter five provides a justification for including relaxation techniques as part of the larger approach to overcoming neck and back pain. It discusses practical stress management briefly, outlines the current understanding of stress and its effects on the body, and ends with an easy-to-learn method for relaxation. Useful guided visualization techniques for speeding up the heating process are included in the relaxation script.
Cautions
Before you begin, some notes of caution must be sounded. If you are undergoing some form of treatment at the moment, you must discuss the exercises presented in the book with your practitioner before beginning. It is a matter both of courtesy and safety -- some of the exercises may be inappropriate for your condition. Further, embarking on a course of exercises that have not been examined or approved by your practitioner may void any comp...
